Intramedullary nailing of tibial shaft fractures: a scoping review
1 Centre for Orthopaedic and Trauma Research, Adelaide Medical School, The University of Adelaide, Adelaide, Australia
2 Department of Orthopaedics and Trauma, Royal Adelaide Hospital, Adelaide, Australia
Intramedullary (IM) nailing is the typical fixation for adult tibial shaft fractures, the most common long bone fracture [1]. Techniques to perform IM nailing vary, and studies comparing approaches show conflicting results. The absence of a validated, cohort-specific outcome measure has led to a wide range of outcome measures reported, making comparisons difficult. The true extent and prevalence of outcome measures in use is currently not known.
PubMed and Embase databases were searched in November 2021. Covidence™ was used for article screening and data extraction. All study designs and populations were included. Ex vivo studies without the presence of tibial shaft fracture were included; studies reporting on open or intra-articular fractures only, or other fracture fixation were excluded. The methodology followed current scoping review guidelines [2, 3].
Figure 1: PRISMA flowchart.
| Approach | nfracs | % | ntibias | % | Total | % |
|---|---|---|---|---|---|---|
| IPN | 6147 | 48.8 | 199 | 54.5 | 6346 | 49 |
| SE | 432 | 3.4 | – | – | 432 | 3.3 |
| SPN | 1869 | 14.8 | 110 | 30.1 | 1979 | 15.3 |
| ND | 4141 | 32.9 | 56 | 15.3 | 4197 | 32.4 |
| Totals | 12589 | 100 | 365 | 100 | 12954 | 100 |
Figure 2: Number of publications per year grouped by IM nailing focus. All “fracture” publications in PubMed also presented.
Figure 3: Patient outcomes for in vivo studies grouped by IM nailing focus. See supplementary material for full list of patient outcomes.
Figure 4: Clinical outcomes for in vivo studies grouped by IM nailing focus. See supplementary material for full list of clinical outcomes.
Figure 5: Ditribution of papers describing important study characteristics.
Figure 6: Outcomes for ex vivo studies grouped by IM nailing focus. See supplementary material for full list of outcomes.
This is the first study to detail the outcome measures used in this cohort. There was found to be considerable heterogeneity in reporting. The most frequent modality was simply asking whether any knee pain exists. Notably, a number of the scores routinely used were designed for other pathologies and do not contain a kneeling component, shown to cause the most severe pain within this cohort [4]. These results have highlighted a number of gaps in the literature and provide motivation for a validated, cohort-specific outcome measure. This work should ultimately help to inform surgical decision-making on whether an optimal IM nailing technique exists.
IM – intramedullary; IPN – infrapatellar nail; SE – Semi-extended; SPN – suprapatellar nail; ND – no description; NA – not applicable; ROM – range of motion; VAS – visual analogue score; NRS – numerical rating score.
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Intramedullary nailing of tibial shaft fractures: a scoping review